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目的探讨在经鼻内镜泪囊鼻腔吻合术中应用丝裂霉素C、5-氟尿嘧啶、透明质酸钠治疗慢性泪囊炎的临床疗效。方法将155例(166眼)慢性泪囊炎患者随机分为丝裂霉素C组(MMC组)、5-氟尿嘧啶组(5-Fu组)、透明质酸钠组(SH组)和对照组。在经鼻内镜泪囊鼻腔吻合术中局部分别应用0.4 mg/mL丝裂霉素C、50 mg/mL5-Fu、10 mg/mL透明质酸钠;对照组仅行经鼻内镜泪囊鼻腔吻合术,术中不用药物;术后随访12个月,观察患者泪道通畅情况,鼻内镜下测量造瘘口面积,检查鼻腔结构恢复情况。结果①MMC组44眼治愈43眼,治愈率97.7%;5-Fu组38眼治愈35眼,治愈率92.1%;SH组44眼治愈40眼,治愈率90.9%。对照组40眼治愈35眼,治愈率87.5%,手术治愈率明显高于对照组,其差异有统计学意义(χ2=5.62,P=0.019;χ2=7.84,P=0.029;χ2=5.78,P=0.016)。治疗组的治愈率与对照组的治愈率比较差异有统计学意义(P<0.05);②术后6个月对照组与治疗组间吻合口大小差异有统计学意义(F=6.096,P=0.006)。但治疗组间差异无统计学意义(P=0.564)。术后12个月,前3组造瘘口面积都明显大于对照组(F=6.162,P=0.002);MMC组术后造瘘口面积大于5-Fu组,差异有统计学意义(P=0.022)。MMC组术后造瘘口面积大于SH组,差异有统计学意义(P=0.034)。5-Fu、SH组两组间比较,差异无统计学意义(P=0.719)。结论在经鼻内镜泪囊鼻腔造瘘术中局部应用药物能有效提高手术治愈率,并且应用MMC效果优于5-Fu和SH。
Objective To investigate the clinical efficacy of mitomycin C, 5-fluorouracil and sodium hyaluronate in the treatment of chronic dacryocystitis in nasal endoscopic dacryocystorhinostomy. Methods 155 patients (166 eyes) with chronic dacryocystitis were randomly divided into mitomycin C group (MMC group), 5-fluorouracil group (5-Fu group), sodium hyaluronate group (SH group) and control group . In nasal endoscopic dacryocystorhinostomy were applied 0.4 mg / mL mitomycin C, 50 mg / mL 5-Fu, 10 mg / mL sodium hyaluronate; control group only through endoscopic dacryocyst nasal cavity Anastomosis, intraoperative no drugs; postoperative follow-up of 12 months to observe the patient’s lacrimal patency, nasal endoscopic stoma area measurements to check the nasal structure recovery. RESULTS: Forty-four eyes were cured in 44 eyes of MMC group, the cure rate was 97.7%. In 35 eyes treated with 5-Fu group, 35 eyes were cured and the cure rate was 92.1%. Forty eyes were cured with 40 eyes. The cure rate was 90.9%. The cure rate was 87.5% in 40 eyes of the control group, and the cure rate was significantly higher than that of the control group (χ2 = 5.62, P = 0.019; χ2 = 7.84, P = 0.029; = 0.016). The cure rate in the treatment group was significantly different from that in the control group (P <0.05). ② The anastomotic size of the control group and the treatment group at 6 months after operation was significantly different (F = 6.096, P = 0.006). However, there was no significant difference between treatment groups (P = 0.564). At 12 months after operation, the area of stoma in the first three groups was significantly larger than that in the control group (F = 6.162, P = 0.002). The area of stoma in MMC group was larger than that of 5-Fu group (P = 0.022). The area of stoma in MMC group was larger than that in SH group, the difference was statistically significant (P = 0.034). There was no significant difference between the 5-Fu and SH groups (P = 0.719). Conclusion Topical application of nasal endoscopic dacryocystorhinostomy can effectively improve the cure rate, and the application of MMC is better than 5-Fu and SH.